Depersonalization-derealization disorder
[10] Diagnostic criteria for depersonalization-derealization disorder includes persistent or recurrent feelings of detachment from one's mental or bodily processes or from one's surroundings.
[11] A diagnosis is made when the dissociation is persistent, interferes with the social or occupational functions of daily life, and/or causes marked distress in the patient.
[14][15] While brief episodes of depersonalization or derealization can be common in the general population, the disorder is only diagnosed when these symptoms cause substantial distress or impair social, occupational, or other important areas of functioning.
[17] First experiences with depersonalization may be frightening, with patients fearing loss of control, dissociation from the rest of society and functional impairment.
[23] Factors that tend to diminish symptoms are comforting personal interactions, intense physical or emotional stimulation, and relaxation.
[30] Patients with high interpersonal abuse histories (HIA) show significantly higher scores on the Cambridge Depersonalization Scale, when compared to a control group.
[33] People who live in highly individualistic cultures may be more vulnerable to depersonalization due to a hypersensitivity towards threats and fears of losing control.
Users reportedly experienced higher levels of a lessened sense of presence in reality after exposure to VR.
There is converging evidence that the prefrontal cortex may inhibit neural circuits that normally form the basis of emotional experience.
[38] In a test of skin conductance responses to unpleasant stimuli, the subjects showed a selective inhibitory mechanism on emotional processing.
[39] Studies are beginning to show that the temporoparietal junction has a role in multisensory integration, embodiment, and self-other distinction.
[40] Several studies analyzing brain MRI findings from DPDR patients found decreased cortical thickness in the right middle temporal gyrus, reduction in grey matter volume in the right caudate, thalamus, and occipital gyri, as well as lower white matter integrity in the left temporal and right temporoparietal regions.
[41][42][43] A PET scan found functional abnormalities in the visual, auditory, and somatosensory cortex, as well as in areas responsible for an integrated body schema.
The vestibular system helps control balance, spatial orientation, motor coordination, but also plays a role in self-awareness.
Several studies have shown that patients with peripheral vestibular disease are also more likely to have dissociative symptoms when compared to healthy individuals.
[4] DPDR differentials include neurologic and psychiatric conditions as well as side effects from psychoactive substances or medications.
Some clinicians speculate that this could be due to a delay in diagnosis by which point symptoms tend to be constant and less responsive to treatment.
[64] Psychoeducation involves counseling regarding the disorder, reassurance, and emphasis on DPDR as a perceptual disturbance rather than a true physical experience.
[12] Clinical pharmacotherapy research continues to explore a number of possible options, including selective serotonin reuptake inhibitors (SSRI), benzodiazepines, stimulants and opioid antagonists (ex: naltrexone).
[12] An open study of cognitive behavioral therapy has aimed to help patients reinterpret their symptoms in a nonthreatening way, leading to an improvement on several standardized measures.
[66] Modafinil used alone has been reported to be effective in a subgroup of individuals with depersonalization disorder (those who have attentional impairments, under-arousal and hypersomnia).
[68][69][70] One study examined 12 patients with DPDR that were treated with right temporoparietal junction (TPJ) rTMS and found that 50% showed improvement after three weeks of treatment.
[68] Michal et al. (2016) analyzed a case series on 223 patients suffering from DPDR and agreed that the condition tended to be long-lasting.
[24][25] According to the DSM-5-TR, less than 20% of patients with the disorder first experience symptoms after age 20 years; 80% or more have their onset in the first 2 decades of life - childhood and adolescence.
[25] Insidious onset may reach back as far as can be remembered (early childhood), or it may begin with smaller episodes of lesser severity that become gradually more intense and more disabling.
The 8 July 1880 entry reads: I find myself regarding existence as though from beyond the tomb, from another world; all is strange to me; I am, as it were, outside my own body and individuality; I am depersonalized, detached, cut adrift.
Maurice Krishaber proposed depersonalization was the result of pathological changes to the body's sensory modalities which lead to experiences of "self-strangeness" and the description of one patient who "feels that he is no longer himself".
The sensory hypothesis was challenged by others who suggested that patient complaints were being taken too literally and that some descriptions were metaphors – attempts to describe experiences that are difficult to articulate in words.
[80] In order to comprehend the nature of reality we must incorporate all the subjective experiences throughout and thus the problem of obtaining an objective definition is brought about again.
[82] In Glen Hirshberg's novel The Snowman's Children, main female plot characters throughout the book had a condition that is revealed to be depersonalization disorder.
